초음파 촬영에 의한 태아체중 예측에 대한 임상적 고찰

김성환(SW Kim),황윤영(YY Hwang) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.1

결론 초음파 촬영후 48시간 이내에 산택적 제왕절개술이 시행된 112예에서 초음파 측정치와 태아체중 예측치를 출생후 실측치와 실 체중치를 비교하여 다음과 같은 결론을 얻었다. 1. 절대오차의 평균은 220.6gm, 백분율은 6.57%이었고 머차의 표준편차는 48.0gm/kg 이었다. 2. 실체중치의 5% 이내로 예측된 경우가 45.5%, 10% 이내로 예측된 경우가 75.0% 이었다. 3. 초 파애 의한 아두대횡경과 복위의 측청치는 실측치보다 아두대횡경은 평균 2.2% 작(P<0.005), 복위는 평균 10.2% 크게 (P<0.001) 측정되었다, 4.아두대횡경은 태아체중이 낮게 예측된 군에서나 높게 예측된 군에서 모두 같은 비율로 (P>0.1) 작게 측정되었으며, 복위는 양군에서 모두 크게 측정되었으 나 태아체중이 높게 예측된 군에서 훨씬 높은 비율로 (p<0.001) 크게 측정되었다. 즉, 아두대횡경보다 복 위가 태아체중의 예측에 더 영향을 주었다. 5.아두대횡경과 복위를 이용한 태아체중의 예측방법 (공식 E2)은 한국인 태아에게도 상당한 정확도로 유용하였다. Accurate estimation of fetal weight helps obstetricians to decide a mode of obste-tric managements and to detect intrauterine growth retardation, and it contributes to reduce neonatal mortality and morbidity. The ultrasonographic estimation of fetal weight utilizing BPD and AC suggested by Warsorf et al has been widely used with considerable accuracy. This study is a clinical trial to evaluate the accuracy of the uitrasonographic estimation of fetal weight for the Korean fetuses and the influences of BPD and abdominal circumference on the estimation of feta[ weight Eⅹcluding the vaginal deliveries which were thought to affect the BPD during delivery, accuracy of the estimation was evaluated in 112 patients who underwent electiv Cesarean section and the influences of BPD and abdominal circumference on the estimation of fetal weight were assessed in 60 patients by comapring sonograpic BPD and AC with actual ones. The results are as follows: 1).Absolute mean error of this sonographic estimation of fetal weight was 220.6gm, percentage of error 6.57%, and standard deviation of error 48.0gm/kg. 2) Estimates of fetal weight within 5% and 10% of actual birth weight were 45.5% and 75.0% respectively. 3) Sonographic measurement of BPD was 2.2% Iess than actual measurement(p0.1) both in the groups of underestimates and overestimates of fetal weight, but sonographic AC was overmeasured at the much higer rate (p<0.001) in the group of over-estimates than in the group of underestimates It indicates that sonographic AC affects the estimation of fetal weight more than BPD. It is believed that the sonographic estimation of fetal weight by equation (E2) can be applied on Korean fetuses with reasonable accuracy.

위점액종성 복막염 1 예

김성환(SW Kim),김인식(IS Kim),김용대(YD Kim),최인범(IB Choi) 대한산부인과학회 1975 Obstetrics & Gynecology Science Vol.18 No.8

1) Histological apearance는 양성이고 Clinical appearance는 악성이며, 2) 침윤성종양은 극히 드무나 대새는 악성이다. 3) 내장침입 및 전이는 극히 적으며 대개는 Extensive intraperitoneal spread이며 4) 조기 진단, 적극적인 외과적 처치만이 이 병을 호전시킬 수 있으며, 5) Radiation과 Systemic chemotherapy는 이 병의 natural course와 예후에 그렇게 효과가 없는 것으로 판단됨. A Case of pseudomyxoma peritonei is reported. This case of pseudomyxoma peritonei is discussed briefly from the points of view of the etiology, incidence, symptoms diagnosis prognosis and treatment.

폐경 후 여성에서 경피적 에스트로겐 보충요법시 병행 투여된 활성형 비타민 D의 골밀도 및 골대사에 미치는 영향에 관한 연구

김성환(SW Kim),박은동(ED Park),김도형(DH Kim),김흥열(HY Kim),석원일(WI Suk),서남원(NW Seo),이상민(SM Lee),노선화(SH Noh) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.4

To evaluate the impacts of vitamin-D on the bone mineral density and bone metabolism in the estrogen replacement 1-year trials of 3 grops: Group 1 was 35 wemen recieved the treatment with 0.5 ㎍ of vitamin D daily by oral administration, Group Ⅱ was 50 wemen recieved the treatment with 50 ㎍ of 17 β-estradiol by percutaneous administration, Group Ⅲ was 35 wemen recieved with percutaneous estrogen with daily addition of vitamin D. In all subjects, bone mineral density (BMD) of lumbar spine and femur neck, urinary calcium/creatinine ratio, and serum osteocalcin were measured before treatment and after 6 and 12 months of treatment. BMD of femur neck in Group I, Group Ⅱ and Group Ⅲ increased but not significantly compared to basal level at 6 months and/or 12 months of treatment. As for BMD of lumbar spine, it increased significantly during the treatment in Group Ⅱ and Group Ⅲ, but not in Group Ⅰ. Serum osteocalcin in Group Ⅱ and Group Ⅲ decreased significanly at 12 months of treatment compared with Group Ⅰ. Urinary calcium/creatinine ratio in Group Ⅱ, Group Ⅲ, decreased significantly at 12 months of treatment compared with Group I. From the above results, it might be suggested that combined therapy (percutaneous estrogen with daily addition of vitamin D) is more effective in post menopausal women with the protection on decreasing bone mineral density.

지혈곤란한 골반장기 출혈시 내장골동맥 결찰술에 대하여

김성환(SW Kim),이동준(DJ Lee),윤성도(SD Yoon),서영욱(YU Suh) 대한산부인과학회 1980 Obstetrics & Gynecology Science Vol.23 No.8

내장골 동맥결찰술은 안전하고 효과적인 골반장기 지혈 방법이다. 저자들은 1975년 1월부터 1978년 12월말까지 7예의 내장골 동맥 결찰술을 시행하여 만족할만한 효과를 거두었으며 총 7예중 2예는 일측성결찰, 5예는 양측성 결찰을 시행하여 간략한 문헌고찰을 하여 본학회에 보고하는 바이다. Ligation of the internal iliac artery in the control of severe spontaneous or operative hemorrhage is little known and seldom used in the present day practice of obstetrics and gynecology. This is not because the procedure is ineffective, dangerous, or even difficult to do: it is none of these. It is simply because most practioner do not know about it. The majority of residents currently in training will finish without seeing the operation. The purpose of this presentation is to demonstrate our surgical results in the management of intractable pelvic hemorrhage with a very simple & usually effective technic, hypogastric artery ligation. From Jan. 1975 to Dec. of 1978, therapeutic ligation of hypogastric arteries were done in 7 patients. It was performed unilateral in 2 and bilateral in 5 cases. No additional ovarian arteries were ligated. No death or serious complications was resulted directly from artery ligation itself. Ligation of the hypogastric artery can be life saving.

Krukenberg 종양의 4예

강대경(DK Kang),김성환(SW Kim),김인식(IS Kim),정재훈(JH Chung) 대한산부인과학회 1973 Obstetrics & Gynecology Science Vol.16 No.7

We have experienced 4 cases of Krukenberg`s tumor of ovary during 5 years survey from Jan. 1967 to Jan. 1971. in Maryknoll Hospital. Krukenberg`s tumor are generally believed that it is almost metastatic tumor from G.I. tract or breast, but Novak have pointed that about 20 percent seem primary in nature. In our cases, 3 cases have distinct origin and one can`t find accurate original site. And here we represent case presentation and review of literature was made briefly.

항암제 Cis - platinum 의 독성에 관한 연구

신승주(SJ Shin),김성환(SW Kim),조수현(SH Cho),배동한(DH Bae),강길전(KC kang),김두상(DS Kim) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.2

결 론 1981년 12월부터 1982년 8월까지 한양대학병원 산부인과학 교실에서 D.D.P.를 사용하여 최소 3회 이상의 화학 치료를 받았던 자궁경부암 환자 12예를 대상으로 그 독성을 조사분석하였던 바. 다음과 같은 결론을 얻었다. 1. 청신경독성은 조사한 8예중 3예(37.5%)에서 나타났으며 전 예에서 양측성이었고 그 중 2예는 고음, 나머지 1예는 저음청각장애이었다. 2. 빈혈은 총 12예중 4예(33.3%)에서 나타났으며 대부분 ndrmochromic eormocytic anemia였으며 수혈로 교정이 가능하였다. 3. 골수에 대한 독성은 총 치료 50회중 백혈구 감소증은 23회(46%), 혈소판 감소증은 6회(12%)로 나타났으며 이는 가역적이었고 심한 중증의 예나 패혈증등은 나타나지 않았다. 4. 신장독성은 BUN의 증가가 12예중 4예(33.3%)에서 나타났고 혈청 creatininel의 증가가 12예중 2예(16.6%),BUN과 creatinined의 동시 증가가 12예중 4예(S3.3%)로 나타나 총 12예중 10예(83.3%)에서 나타났고 모두 경중이었다. 또한 신장독성은 투여 용량에 비례 하였고 가역적이었다. 5. 위장관계에 대한 독성은 주로 오심 및 구토증이었는데 이는 전 예에서 나타났으며 가장 환자에게 고통을 주는 요인이었으며 perrphenazinedp 의한 항오심 효과는 다른 약물에 비하여 비교적 강한 경향을 보였다. The toxicity of cis-platinum was evaluated in 12 patients who were treated for advanced or recurrent squamous cell carcinoma of the cervix with the dosage schedule of 2Omg/m of 5 days every 3 weeks at the Department of 0bstet. and Gynecol., Hanyang University Hospital from Dec.1981 through Aug.1982. The results were as follows: 1. The most frequent and troublesome side effects were gastrointestinal symptoms of nausea and vomitings that occurred in all cases. These side effects were more tolerable in the patients treated with perphenazine than those with chloropromazine. 2. Nephrotoxicity was noted in 33.3%(4/12) of patients as determined by an elevation of BUN, in 16.6%(2/12) by an elevation of serum creatinine and in 33.3%(4/12) by an elevation of serum creatinine and BUN. The toxicities were all in mild degree, dose related and reversible. 3. For the hematologic toxicity, leukopenia occurred in 58.3%(7/12) of the patients, thromcytopenia in 41.7% (5/12), and anemia in 33.3% (4/12).They were reversibie and not life threatening· 4. Ototoxicity occurred in 37.5%(3/8) of patients with bilateral involvements in all cases.

임신주수에 따른 신생아 신체측정치의 정상분포

신영우(YW Shin),계영선(YS Kye),김성환(SW Kim),문형(H Moon),김두상(DS Kim) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.6

1. 본 보고의 신생아 체중은 36주에서 평균이 2,660 ±406gm이었으며, 제10, 90백분위수에 해당하는 측 정치는 각각 2,140gm, 3,179gm이었다. 또 40주에 서 평균체중은 3,240±398gm이었고, 제10, 90백분 위수 측정치는 각각 2,730gm, 3,749gm이었다. 2. BPD는 36주에서 평균이 9.00±0.5cm이었으며 제 10, 90백분위수 측정치는 각각 8.36cm, 9.64cm이 었다. 40주에서 평균 BPD는 9.46±0.45cm이었고, 제10, 90백분위수 측정치는 각각 8.88cm, 10.03cm 이었다. 3. 두위는 36주에서 평균이 32.8±1.56cm이었고, 제 10, 90백분위수 측정치는 각각 30.8cm, 34.0cm 이었다. 40주에서 평균두위는 34.5±1.39cm이었으 며, 제 10, 90백분위수 측정치는 각각 32.7cm, 36.3 cm이었다. 4, 북위는 36주에서 평균이 27.5±2.34cm이었고 제10, 90백분위수 측정치는 각각 24.5cm, 30.5cm이 었다. 40주에서 평균복위는 31.2±2.24cm이었고 제 10, 90백분위수 측정치는 각각 28.3cm, 34.1cm이 었다. 5. 흉위는 36주에서 평균이 30.2±2.34cm이었고 제10, 90백분위수 측정치는 각각 27.2cm, 33.2cm이 었다. 40주에서 평균흉위는 33.0±1.64cm이었으며 제10, 90백분위수 측정치는 각각 33.9cm, 35.1cm이 었다. 6. 두위대 복위비의 평균치는 36주에서 1.20±0.091 이었으며 제10, 90백분위수 측정치는 각각 1.08, 1.31 이었다. 40주에서 평균치는 1.11±0.067이었고 제 10, 90백분위수 측정치는 각각 1.02, 1.20이었다. 이상과 같이 신생아 신체측정치들에 대한 주수별 정 상분포도를 작성하였으며 우리 상황에 맞는 분포도를 기준으로 자궁내 태아발육지연이나 과숙아의 산전진단 과 적극적인 산과적 처치를 함으로써 주산기 사망율과 이환율의 감소가 기대되는 바이다. The anthropometric measurements including birth weight, biparietal diameter, head circumference, chest circumference, abdominal circumfernce, and HC/AC, have been proved to be valuable ln prognostic evaluation of the newborns. There are, however, no available nomograms of the anthropometric measurements except birth weights for the Korean infants. This study was carried on to construct the nomo- grams for the Korean infants of the anthropometric measurements according to the duration of pregnancy. The study group comprised 2,142 newborn infants delⅳered at the Department of Obstetrics and Gynecology, Hanyang Unⅳersity Hospital during the period from Jan. 1, 1981 to Dec. 31, 1981. Results were as follows: 1. The birth weights for the lOth, 50th, and 9Oth percentile according to the gestational ages were 2,140gm, 2,660gm, and 3,179gm at the 36th week; and 2,730gm, 3,240gm, and 3,749gm at the 40th week respectively 2. The BPDs for the lOth, 50th, and 90th percentile according to the gestational ages were 8.36cm, 9.00cm, and 9.64cm at the 36th week: and 8.88cm, 9.46cm, and 10.03cm at the 40th week respectively. 3. The head circumferences for the lOth, 50th, and 9Oth percentile according to the gestational ages were 30.8cm, 32.8cm, and 34.Ocm at the 36th week; and 32.7cm, 34.5cm and 36.3cm at the 40th week respectively. 4. The abdominal circumfereces for the 1Oth, 50th, and 90th percentile according to the gestational ages were 24.5cm 27.5cm, and 30.5cm at the 36th week; and 28.3cm, 31.2cm, and 34.1cm at the 40th week respectively 5. The chest circumferences for the 10th, 50th, and 90th percentile according to the gestational ages were 27.2cm, 30.2cm, and 33.2cm at the 36th week; and 30.9cm, 33.0cm, and 35.1cm at the 40th week respectively. 6. The ratios of HC/AC for the 10th, 50th, and 90th percentile according to the gestational ages were 1.08, 1.20, and 1.31 at the 36th week; and 1.02, 1.11, and 1.20 at the 40th week respectively.

두흉결합체의 쌍태 기형아의 1예

배국환(KH Bae),하옥근(OK Ha),강대경(DK Kang),김성환(SW Kim),정재훈(JH Chung) 대한산부인과학회 1973 Obstetrics & Gynecology Science Vol.16 No.2

A case of cephalothoracopagus in monozygotic female twins is reported. The case is discussed briefly from the points of view of etiology, incidence, problem of delivery, postnatal correction of the abnormal condition, and finally the prognosis in future pregnancies.

비장적출술에 의한 임신중 혈소판감소성 자반증의 치험 1 례

손대언(DY Soon),문경란(KL Moon),박일옹(IO Park),김구현(GH Kim),조상무(SM Cho),송창훈(CH Song),장하종(HJ Jang),한세준(SJ Han),김성환(SW Kim) 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.2

Immunologic thrombocytopenic prupura during pregnancy is the most common autoimmune disease caused by early destruction of an autoantibody mediated maternal platelet by the reticuloendothelial system. It is of particular concern during pregnancy because the placenta actively transports IgG autoantibodies from maternal to fetal circulation. This may or may not cause thrombocytopenia in the fetus, as well as the major risk of central nervous system hemorrhage during vaginal delivery, and spontaneous abortion or postpartum hemorrhage in the mother. The various therapeutic methods that have been used are corticosteriod, splenectomy, platelet transfusin, immunosuppressive drugs, high dose immunoglobulin, and other. We have expreienced a case of immunologic thrombocytopenic purpura, diagnosed at the 13th week of pregnancy, and treated with splenectomy. The patient gave birth to intrauterine growth retarded female vaginally at 37 weeks 3days of pregnancy and the newborn was admitted to the newborn intensive care unit, but healthfully discharged. A brief review of the case and its literature is pressented.